Before Illinois leaps

March 04, 2007

Almost everyone agrees that people should have health insurance. But what if you can't afford it? Or what if you are young and don't think you're going to get sick? Or what if you lose your job and insurance companies think you're a bad risk? Or ... There are a thousand what-if's, leading to a stark figure: upward of 47 million Americans--including about 1.4 million adults in Illinois--without health insurance.

The federal government has been spectacularly inept at solving this shortcoming. So in recent years, the states have taken the lead. Last year in Massachusetts, Republican Gov. Mitt Romney and a Democratic legislature agreed on an ambitious and innovative attempt at universal health insurance coverage. It was highly acclaimed as a bipartisan effort. Most notably, it required all residents to get health insurance. Those who can afford insurance are mandated to buy it. Those of limited means receive subsidies. Anyone who refuses will be penalized.

That plan helped galvanize other states to stop waiting for the federal government to solve the crisis and try to do so themselves. California Gov. Arnold Schwarzenegger muscled in with his own ambitious plans. On Sunday, Gov. Rod Blagojevich is expected to roll out his proposal to expand access to coverage in Illinois.

The early word: It's considerably less ambitious than the Bay State's plan, in that it won't attempt to cover everyone in the state currently without coverage. Nor will it force everyone to acquire insurance. But it's still breathtakingly expensive and complex.

There's likely to be a long debate ahead in Springfield over Blagojevich's plan. Luckily, Illinois lawmakers and officials aren't venturing into uncharted territory here: Massachusetts has become a fascinating crucible for other states to learn what to do--and not do.

So far, what Massachusetts lawmakers and regulators seem to be learning is that sweeping health-care reform is a lot harder than it looks. And it looks really, really hard.

The Massachusetts plan isn't set to take full effect until July 1. But some critics already are predicting its imminent demise or diminishment, suggesting that the new Democratic governor and legislature won't enforce the most dramatic element of the plan--the mandate that all residents acquire insurance or else face penalties.

Even Romney, now running for president, is suggesting that he can't be held responsible if the plan falters because Democrats are unable to make tough decisions. And there are lots of tough decisions to be made.

So what could Blagojevich and Illinois learn from Massachusetts? Plenty.

For one thing, don't underestimate the cost, to the state or to potential insurance buyers. Blagojevich's plan would create a new "affordable" comprehensive insurance plan that anyone without employer-sponsored coverage in Illinois could buy. It would let small-business owners buy this insurance for their employees, under certain conditions. And it would offer premium subsidies for individuals earning up to about $40,000 and families earning as much as $80,000 or so.

Romney also promised "affordable" insurance for workers earning more than $30,000 a year who didn't currently have coverage. He suggested annual premiums for a single worker might reach $200 a month. But when insurance companies provided their first estimates of what the cost would be, the figures staggered public officials: $4,560 a year--or $380 a month. Why? Probably because regulators were insisting on an extensive prescription drug benefit in the plans, as well as other coverage mandates.

Big mistake--if one goal is low premiums. The broader the coverage, the costlier the insurance.

Another mistake: The Boston Globe recently reported that more than 200,000 people who already had health insurance would have to buy more coverage to meet the proposed minimum standards--or ostensibly face a state penalty. Many of them didn't have coverage for prescription drugs, or had drug coverage that is more limited than the proposed standards. All of that is still under negotiation.

Memo to Illinois lawmakers: Unfortunately, "affordable" and "comprehensive" don't often fit in the same sentence when describing health insurance. The basic aims of publicly assisted insurance coverage--affordable for currently uninsured citizens and for taxpayers--are simple: To give people access to essential care. To rescue those who otherwise would face overwhelming medical bills. And to ease the burden of hospitals now forced to pick up the tabs of people who can't pay. That's it.

Romney et al. are clawing for the political glory that comes with being anointed as The One Who Solved the Uninsured Crisis. Let 'em claw. It took years of intense wrangling in the Massachusetts legislature before lawmakers and the governor finally reached a deal. As we're seeing now, that was the easy part.